Volume 2 • Issue 5 • 1000112Anat PhysiolISSN:2161-0940 Physiol, an open access journal

Open AccessResearch Article

Sharada Sharma et al., Anat Physiol 2012, 2:5 DOI: 10.4172/2161-0940.1000112

Keywords: Situs Inversus Totalis (SIT); Dextrocardia (DC);Superiorvenacava (SVC)

IntroductionSitus inversus is a short form of the Latin phrase “Situs inversus

Viscerum” meaning “inverted position of the internal organs, as first described by Marco Severino in 1643. All dead, aborted foetuses are dissected in the Department of anatomy of KIMS, Narketpally. The index case showed the Situs inversus totalis.

The incidence is about 1:10,000 live people. Normal human development results in an asymmetrical arrangement of the organs within the chest and abdomen. Typically, the heart lies on the left side of the body (levocardia), the liver and spleen lie on the right. Mirror image i.e. transposition of abdominal and thoracic viscera is termed Situs inversus totalis. It has shown the anomalies of rotation, fixation during the development, a perfect mirror image. Such relationship between the organs is does not lead to functional problems in most.

The apex of the heart is located on the right side of the thorax, the stomach and spleen on the right hypochondriac region in the abdomen and the large lobe of the liver and gallbladder on the left side. The left lung is tri-lobbed and the right lung bi-lobbed, and blood vessels, nerves, lymphatics and the intestines are also transposed (Figure 1).

Materials and MethodsAn unknown dead, aborted fetus was dissected at Department

of Anatomy, KIMS, Narketpally. Detailed protocol parameters of Morphometric and Internal Anatomy were studied.

MethodsNormal dissection method for foetal autopsy from standard text books.

ObservationThe condition affects all major structures within the thorax and

abdomen. Generally, the organs are simply transposed through the sagittal plane. The SITUS INVERSUS TOTALIS study was done and observations are tabulated (Figures 2 and 3; Tables 1-3).

Results Situs inversus is rare with incidence of one in ten thousand.

Surgeons and radiologists should be aware of this anomaly, during preoperative and surgical management. Encouragement of routine premedical examination helps the patient to be aware of his condition, thereby preventing wrong diagnosis possibly leading to death due to delay in surgical management. Dextrocardia with Situs inversus is asymptomatic. Situs inversus totalis in dead aborted foetuses is

*Corresponding author: Sharada Sharma, Kamineni Institute of Medical Sciences, Sreepuram, Narketpally, Nalgonda (Dist), India, E-mail: saradahogirala@gmail.com

Received October 22, 2012; Accepted December 20, 2012; Published December 22, 2012

Citation: Sharada Sharma, Chaitanya KK, Suseelamma D (2012) Situs Inversus Totalis (Dextroversion) - An Anatomical Study. Anat Physiol 2:112. doi:10.4172/2161-0940.1000112

Copyright: © 2012 Sharada Sharma, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

A female, dead abortus was studied in detail for academic interest. Detailed study revealed Situs inversus totalis. By this study an anatomical, embryological exploration for reverse organogenesis is proposed.

Situs inversus totalis with dextrocardia was detected incidentally in an aborted foetus in routine dissection kept for research work in Kamineni Institute of Medical Sciences, narketpally. The term Situs inversus is a short form of the Latin phrase “Situs inversus viscerum”, meaning inverted position of the internal organs.

The Situs inversus totalis is a rare syndrome, with an estimated prevalence of 1/10,000 births, characterized by the inverted position of the thoracic and abdominal organs with respect to the sagittal plane.

Situs inversus totalis, a not so uncommon congenital positional anomaly can be a diagnostic problem at times. The condition affects all major structures within the thorax and abdomen. Surgeons and radiologists should be aware of this anomaly, during preoperative and surgical management. Routine premedical examination helps the patient to be aware of his condition, thereby preventing wrong diagnosis possibly death due to delay in surgical management.

Situs Inversus Totalis (Dextroversion) - An Anatomical StudySharada Sharma*, Chaitanya KK and Suseelamma D

Kamineni Institute of Medical Sciences, Sreepuram, Narketpally, Nalgonda (Dist), India

Figure 1: Fetus with Situs Inversus totalis.

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Citation: Sharada Sharma, Chaitanya KK, Suseelamma D (2012) Situs Inversus Totalis (Dextroversion) - An Anatomical Study. Anat Physiol 2:112. doi:10.4172/2161-0940.1000112

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Volume 2 • Issue 5 • 1000112Anat PhysiolISSN:2161-0940 Physiol, an open access journal

relatively rare.

DiscussionSitus inversus totalis is a condition in which the organs of the chest

and abdomen are arranged in a perfect mirror image reversal of the normal positioning. Situs inversus totalis is a rare condition occurring in about one in ten thousand. This anomaly may not be diagnosed until late life in some cases and it is associated with primary ciliary dyskinesia and splenic malformations. It may be total or incomplete in 10% cases. Levocardia with Situs inversus associated with cardiac anomalies.

Aristotle first detected Situs inversus in animals and considered it a visitation from the gods. The condition was uncovered in cadavers in 1600 but the clinical significance of Situs inversus was not grasped until the advent of X-ray imaging which made diagnosis in humans easy and reliable. Situs inversus is rarely symptomatic except digestive difficulties, in appendicitis, heart sounds liver palpations etc.

Abdur-Rahman et al. reported extrogastria, reverse midgut rotation and intestinal atresia in a neonate [1].

Janchar et al. reported “Situs Inversus: Emergency Evaluations of Atypical Presentations” [2]. It is dangerous if not diagnosed prior to surgery. It may be diagnosed by routine medical examination when cardiac function is examined.

Ainsworth and Claire reported “Left Right and Wrong” [3]. Situs inversus also complicates organ transplantation operation as donor organs will almost certainly comes from situs solicitous (normal), as heart and liver have geometric problems while placing the organs into cavity shaped in mirror image. Orientation of these blood vessels also reversed necessitating steps to be taken so that blood vessels join properly.

Therefore in conclusion Situs inversus is rare with incidence of one in ten thousand. Surgeons and radiologists beware of this anomaly, during preoperative and surgical management. Routine premedical examination helps the patient to be aware of his condition, thereby

Figure 2: Contents of the Thorax and Abdomen.

Figure 3: Microscopic structure of the Kidney.

S.No Features Observation1 CRL 18.1 cm2 BPD 3 cm3. Weight 1.87 kg4. Gestational age 27-30 wks

Table 1: Morphometric study.

Region Name of the organ Observations

Thorax Heart Apex – on Right sideChambers–positioned reversely

Superior venacava (SVC) Formation is normal but seen on the left side.

Inferior vena cava (IVC) Formation is normal but directed on to the left side

Ductus Arteriosus Connects right branch of the pulmonary trunk to arch aorta.

Lungs

On right side two lobes with normal hilar structures, lingula and cardiac

notchOn left side Three lobes with normal

hilar structures,

Diaphragm

Crus, Central tendon, domes

Oesophagus

No herniation, structures passing through diaphragm are on normal

basis

Oesophageal hiatus in diaphragm is towards right side

Abdomen Stomach Infantile, with normal gross features

Spleen Present at Right Hypochondria

LiverLarge left lobe with gallbladder fossa

on its inferior surface, microscopic structure has no cysts presents

Small IntestineLoops of Intestines placed at the

centre without getting fixedDuodenum oriented on left side

Vermiform Appendix Positioned centrally without mesocolon

Large Intestine

Caecum is not sacculated, no ascending colon, transverse colon and rectum placed at the centre of

the cavity.

Kidneys Enormously grown occupying most of the abdomen

Supra Renals According to the shapes they are present reversely

Pelvis Genital Organs Normal, well developed external and internal genital organs

Table 2: Internal Anatomy.

Organs ObservationKidney PolycysticLiver Normal

Table 3: Microscopic anatomy.

Citation: Sharada Sharma, Chaitanya KK, Suseelamma D (2012) Situs Inversus Totalis (Dextroversion) - An Anatomical Study. Anat Physiol 2:112. doi:10.4172/2161-0940.1000112

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Volume 2 • Issue 5 • 1000112Anat PhysiolISSN:2161-0940 Physiol, an open access journal

preventing wrong diagnosis possibly death due to delay in surgical management.

Eroschenko reported that Situs inversus is generally an autosomal recessive genetic condition, although it can be X-linked. There is a 5-10% prevalence of congenital heart disease in individuals with Situs inversus totalis. The incidence of congenital heart disease is 95% in Situs inversus with levocardia [4].

Yokoyama et al. [5] described “Reversal of left-right asymmetry: a Situs inversus mutation”

Lowe et al. [6] reported Conserved left-right asymmetry of nodal expression and alterations in murine situs inversus.

Levin [7] described the “Left-right asymmetry in vertebrate embryogenesis.”

Levin et al. [8] reported “Left/right patterning signals and the independent regulation of different aspects of situs in the chick embryo.”

Logan et al. [9] described “The transcription factor Pitx2 mediates situs-specific morphogenesis in response to left-right asymmetric signals.”

In our study, we observed an aborted fetus showing dextrocardia with transposition of great vessels, lungs and transposition of abdominal viscera. The mechanism responsible for malrotation of intestinal loops is yet to be understood. Evidence from the literature

shows that the direction of rotation under influence of forces exerted by adjacent organs on intestines and its mesentery. Dextrocardia with Situs inversus is asymptomatic.

References

1. Abdur-Rahman LO, Adeniran JO, Taiwo JO (2007) Concurrent dextrogastria, reverse midgut rotation and intestinal atresia in a neonate. J Indian Assoc Paediatr Surg 12: 228-230.

2. Janchar T, Milzman D, Clement M (2000) Situs Inversus: Emergency Evaluations of Atypical Presentations. Am J Emerg Med 18: 349-350.

3. Ainsworth, Claire (2000) New Scientist 166: 40-45.

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5. Yokoyama T, Copeland NG, Jenkins NA, Montgomery CA, Elder FF, et al. (1993) Reversal of left-right asymmetry: a situs inversus mutation. Science 260: 679-682.

6. Lowe LA, Supp DM, Sampath K, Yokoyama T, Wright CV, et al. (1996) Conserved left-right asymmetry of nodal expression and alterations in murine situs inversus. Nature 381: 158-161.

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